Integration of the Pirogov interactive anatomy table into anatomy teaching: A comparative study with cadaveric dissection

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Students (not whole classes) were randomized, so the design is not class-level (or stronger) randomization as required by ERCT C.
    • In a prospective cohort, 188 medical students (139 in Y1 and 49 in Y2) were randomly assigned to the Pirogov table group (Group A, n = 99) or the cadaveric dissection group (Group B, n = 89).
    • Relevant Quotes: 1) "In a prospective cohort, 188 medical students (139 in Y1 and 49 in Y2) were randomly assigned to the Pirogov table group (Group A, n = 99) or the cadaveric dissection group (Group B, n = 89)." (p. 2/11) 2) "Randomization generated in Microsoft Excel using a fixed random seed and permuted blocks of four." (p. 3/11) Detailed Analysis: ERCT criterion C requires randomization at the class level (or a stronger unit, such as schools) to reduce contamination that can happen when individuals within the same classroom/setting receive different conditions. Here, the unit randomized is explicitly "medical students" (individual participants), not intact classes or schools. Although the paper includes contamination-reduction procedures (simultaneous sessions in separate rooms and instructions not to discuss content), those procedural controls do not change the unit of randomization itself. The intervention is also not described as a one-to-one tutoring/personal teaching exception. Final sentence: Criterion C is not met because randomization was at the individual student level rather than at the class (or school) level.
  • E

    Exam-based Assessment

    • Outcomes were measured using a faculty-designed 20-item MCQ rather than a widely recognized standardized exam.
    • Eligible students were enrolled and completed a validated 20-item multiple-choice pre-test designed by the anatomy faculty (S1 File).
    • Relevant Quotes: 1) "Eligible students were enrolled and completed a validated 20-item multiple-choice pre-test designed by the anatomy faculty (S1 File)." (p. 4/11) 2) "Knowledge acquisition: Assessed using a standardized multiple-choice questionnaire (20 items covering musculoskeletal anatomy)." (p. 5/11) 3) "The questionnaire was designed and validated by anatomy faculty, with good internal consistency (Cronbach’s alpha = 0.82)." (p. 5/11) Detailed Analysis: ERCT criterion E requires a standardized, widely recognized exam (for example, a national/state standardized test or a broadly established external exam). While the paper describes the MCQ as "validated" and reports psychometrics (Cronbach’s alpha, difficulty and discrimination indices), it is still an internally created instrument: it was "designed by the anatomy faculty" for this study/context. The word "standardized" here refers to consistent administration and format, not an external standardized exam with broad adoption and comparability across institutions. Final sentence: Criterion E is not met because the assessment was created by the local anatomy faculty rather than being a widely recognized standardized exam.
  • T

    Term Duration

    • The post-test was administered immediately after the sessions, which is far less than one academic term after intervention start.
    • The post-test was administered immediately after the session and before the cross-exposure phase, ensuring no contamination of primary outcome measures.
    • Relevant Quotes: 1) "Both groups attended two teaching sessions on the musculoskeletal system (1.5 h each)." (p. 4/11) 2) "Students then completed a post-test of identical format." (p. 4/11) 3) "The post-test was administered immediately after the session and before the cross-exposure phase, ensuring no contamination of primary outcome measures." (p. 4/11) Detailed Analysis: ERCT criterion T requires that outcomes be measured at least one full academic term (typically ~3-4 months) after the intervention begins, allowing time for effects to stabilize and persist beyond very short-term gains. The quoted procedure shows two short sessions (total 3 hours) and a post-test administered "immediately after the session." This is an immediate post-intervention measurement with no term-length delay from intervention start to outcome measurement. Final sentence: Criterion T is not met because outcomes were measured immediately after instruction rather than at least one academic term later.
  • D

    Documented Control Group

    • The comparison (cadaveric dissection) group and baseline characteristics are described with group sizes and baseline balance checks, meeting the control documentation requirement.
    • In total, 188 students were enrolled and assigned into two groups: • Group A (n = 99): Pirogov table • Group B (n = 89): Cadaveric dissection
    • Relevant Quotes: 1) "In total, 188 students were enrolled and assigned into two groups: • Group A (n = 99): Pirogov table • Group B (n = 89): Cadaveric dissection" (p. 3/11) 2) "Baseline comparability between randomized groups was assessed through independent t-tests (continuous variables) and chi-square tests (categorical variables)." (p. 6/11) 3) "No statistically significant differences were observed in age, gender distribution, or pre-test scores, suggesting acceptable balance at the start of the study." (p. 6/11) 4) "The demographic characteristics of the two study groups were comparable." (p. 6/11) Detailed Analysis: ERCT criterion D requires that the control group be clearly documented, including who they are, what they received, and baseline/demographic information enabling comparison. The paper clearly specifies the two conditions, including the "Cadaveric dissection" comparison group (Group B) and the "Pirogov table" group (Group A), with exact sample sizes. It also reports baseline balance checks and explicitly states that age, gender, and pre-test scores were not significantly different across groups. This provides meaningful documentation that the control/comparison group existed and was comparable at baseline. Final sentence: Criterion D is met because the control/comparison group is clearly defined with group sizes and baseline demographic and performance comparability information.

• Level 2 Criteria

  • S

    School-level RCT

    • Randomization occurred among individual students, not among schools (or equivalent institutions/sites).
    • In a prospective cohort, 188 medical students (139 in Y1 and 49 in Y2) were randomly assigned to the Pirogov table group (Group A, n = 99) or the cadaveric dissection group (Group B, n = 89).
    • Relevant Quotes: 1) "In a prospective cohort, 188 medical students (139 in Y1 and 49 in Y2) were randomly assigned to the Pirogov table group (Group A, n = 99) or the cadaveric dissection group (Group B, n = 89)." (p. 2/11) 2) "This was a prospective study, conducted at the Faculty of Medicine, Vietnam National University Ho Chi Minh City (April 2024–April 2025)." (p. 3/11) Detailed Analysis: ERCT criterion S requires school-level (or equivalent institution/site- level) randomization, meaning whole schools (or analogous sites) are assigned to conditions. The study took place at a single faculty and describes random assignment of "medical students" to conditions. There is no indication that multiple schools (or multiple independent sites) were randomized. Therefore, the design does not meet the school-level randomization requirement. Final sentence: Criterion S is not met because the unit of randomization was students within one institution, not schools or sites.
  • I

    Independent Conduct

    • The paper describes blinding and an independent administrator for allocation, but it does not provide evidence of a truly independent external evaluation team separate from those designing/teaching and building the study instruments.
    • Allocation was concealed in sequentially numbered, opaque, sealed envelopes by an independent administrator.
    • Relevant Quotes: 1) "Allocation was concealed in sequentially numbered, opaque, sealed envelopes by an independent administrator." (p. 3/11) 2) "Test scoring and data analysis were performed by assessors blinded to group assignment." (p. 3/11) 3) "Eligible students were enrolled and completed a validated 20-item multiple-choice pre-test designed by the anatomy faculty (S1 File)." (p. 4/11) 4) "Specifically, both groups were taught by the same pair of anatomy instructors..." (p. 4/11) Detailed Analysis: ERCT criterion I expects the study to be conducted independently from the group that designed the intervention, to reduce risks of bias in implementation and analysis. This paper includes some bias-reducing features (allocation concealment, and assessors blinded to group assignment). However, the paper also states the assessment instrument was "designed by the anatomy faculty" and that instruction was delivered by an instructor team within the same program. The paper does not clearly state that an external third-party evaluation organization (separate from the teaching faculty and study authors) designed the evaluation, managed data collection, and controlled analysis end-to-end. Final sentence: Criterion I is not met because, despite blinding and allocation concealment, the study does not demonstrate third-party independent conduct separate from those creating the study instruments and delivering instruction.
  • Y

    Year Duration

    • Outcomes were measured immediately after teaching sessions, far short of 75% of an academic year after intervention start.
    • The post-test was administered immediately after the session and before the cross-exposure phase, ensuring no contamination of primary outcome measures.
    • Relevant Quotes: 1) "Both groups attended two teaching sessions on the musculoskeletal system (1.5 h each)." (p. 4/11) 2) "The post-test was administered immediately after the session and before the cross-exposure phase, ensuring no contamination of primary outcome measures." (p. 4/11) 3) "This was a prospective study, conducted at the Faculty of Medicine, Vietnam National University Ho Chi Minh City (April 2024–April 2025)." (p. 3/11) Detailed Analysis: ERCT criterion Y requires outcome measurement at least 75% of an academic year after the intervention begins. The timing relevant for Y is the interval from intervention start (for a participant) to outcome measurement (for that participant), not simply the overall calendar window during which the study ran. The study’s primary knowledge outcome is measured via a post-test given "immediately after the session." Even though the project ran during April 2024–April 2025, each participant’s treatment-to-measurement interval is essentially same-day, not year-long. Also, per ERCT instructions, if criterion T is not met then Y is not met; this study clearly fails T due to immediate post-testing. Final sentence: Criterion Y is not met because outcome measurement occurred immediately after instruction rather than after most of an academic year.
  • B

    Balanced Control Group

    • Instructional time and core teaching inputs were standardized across groups, and the control group received a comparable active alternative (cadaveric dissection) rather than a lower-resource condition.
    • Teaching duration, content, and instructors were standardized across groups to ensure comparability.
    • Relevant Quotes: 1) "Both groups attended two teaching sessions on the musculoskeletal system (1.5 h each)." (p. 4/11) 2) "Regarding practice sessions, Group A received instruction using the Pirogov interactive anatomy table (Figs 1 and 2), whereas Group B participated in cadaveric dissection." (p. 4/11) 3) "Teaching duration, content, and instructors were standardized across groups to ensure comparability." (p. 4/11) 4) "Specifically, both groups were taught by the same pair of anatomy instructors..." (p. 4/11) Detailed Analysis: ERCT criterion B asks whether time and resources are balanced between intervention and control, unless extra resources are explicitly the treatment variable being tested. Here, instructional time is the same in both arms (two sessions of equal duration), and the paper states that content, instructors, and lesson plan were standardized across groups. The control condition is not "no treatment"; it is an active, resource-intensive alternative modality (cadaveric dissection). The primary comparison is therefore between two teaching modalities delivered under the same schedule and instructional structure, rather than between unequal exposure/time/budget conditions. The paper does not indicate that one group received additional optional instructional time, extra tutoring, or extra materials beyond the modality itself during the primary pre-test to immediate post-test comparison. Therefore, under the ERCT decision logic, extra time/budget is not the driver of differences, and the groups appear balanced. Final sentence: Criterion B is met because both groups received comparable instructional time and standardized teaching inputs, with an active control rather than a lower-resource condition.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific study was identified in the paper, and a web search did not locate an external replication as of the ERCT check date.
    • Relevant Quotes: 1) "To our knowledge, no controlled study has compared the Pirogov interactive table with cadaveric dissection in this region." (p. 3/11) Detailed Analysis: ERCT criterion R requires evidence that the study has been independently replicated by a different team in a different context and published in a peer-reviewed journal. In the paper itself, the authors position the work as filling a gap ("no controlled study") rather than stating that this specific trial has been replicated. In addition, a web search performed on 2026-02-15 using the DOI, article title, and key author names did not identify any peer-reviewed independent replication of this exact study. Final sentence: Criterion R is not met because no independent replication of this specific study could be identified as of 2026-02-15.
  • A

    All-subject Exams

    • Because criterion E is not met (no standardized external exam), the all-subject standardized exam requirement is automatically not met.
    • Eligible students were enrolled and completed a validated 20-item multiple-choice pre-test designed by the anatomy faculty (S1 File).
    • Relevant Quotes: 1) "Eligible students were enrolled and completed a validated 20-item multiple-choice pre-test designed by the anatomy faculty (S1 File)." (p. 4/11) 2) "Knowledge acquisition: Assessed using a standardized multiple-choice questionnaire (20 items covering musculoskeletal anatomy)." (p. 5/11) Detailed Analysis: ERCT criterion A requires standardized exam-based assessments across all main subjects, and ERCT instructions state that if criterion E is not met then criterion A is not met. This study uses a faculty-designed MCQ focused on musculoskeletal anatomy, not a widely recognized standardized exam, and it does not assess all core subjects. Therefore A fails both because E fails and because the outcome is not an all-subject standardized assessment. Final sentence: Criterion A is not met because standardized exam-based assessment (E) is not satisfied and the study does not assess all main subjects using standardized exams.
  • G

    Graduation Tracking

    • The study does not track participants until graduation, and it also fails the year-duration prerequisite (Y).
    • Second, outcomes were measured immediately after instruction without delayed follow-up; therefore, long-term retention cannot be determined.
    • Relevant Quotes: 1) "Second, outcomes were measured immediately after instruction without delayed follow-up; therefore, long-term retention cannot be determined." (p. 9/11) Detailed Analysis: ERCT criterion G requires tracking participants until graduation, and ERCT instructions state that if criterion Y is not met then G is not met. The authors explicitly acknowledge there was no delayed follow-up beyond the immediate post-test. There is no description of tracking students through the end of medical school (or any graduation milestone). In addition, a web search performed on 2026-02-15 for follow-up publications by the same author team and for the same cohort did not identify any published graduation-tracking follow-up for this study. Final sentence: Criterion G is not met because the study includes only immediate post-testing with no graduation tracking (and Y is not met).
  • P

    Pre-Registered

    • The paper provides IRB approval information but does not provide a public pre-registration record (registry/ID) and date demonstrating registration before data collection.
    • The research protocol was reviewed and approved by the Institutional Review Board of the Faculty of Medicine, Vietnam National University Ho Chi Minh City (Approval No. 05/QD-IRB-VN01.017, dated March 29, 2024).
    • Relevant Quotes: 1) "This was a prospective study, conducted at the Faculty of Medicine, Vietnam National University Ho Chi Minh City (April 2024–April 2025)." (p. 3/11) 2) "The research protocol was reviewed and approved by the Institutional Review Board of the Faculty of Medicine, Vietnam National University Ho Chi Minh City (Approval No. 05/QD-IRB-VN01.017, dated March 29, 2024)." (p. 3/11) Detailed Analysis: ERCT criterion P requires a publicly accessible pre-registered protocol (for example on OSF, ClinicalTrials.gov, ISRCTN, or another registry), and evidence that registration occurred before data collection began. The paper provides ethics/IRB approval and dates, but it does not provide a trial registration or pre-registration identifier/link. A web search performed on 2026-02-15 using the study title, DOI, and IRB approval number did not identify a public pre-registration record tied to this study. Final sentence: Criterion P is not met because no public pre-registration record (with an ID and pre-data-collection date) is provided or could be located as of 2026-02-15.